Long-Term Use of DRG Stimulation Shown Effective in New Study

The intervention may be useful for patients who have not benefited from other pain therapies.

A PPM Brief

A new prospective study1 presented at the 2018 Anesthesiology Annual Meeting evaluated pain and disability in patients with chronic pain who underwent permanent dorsal root ganglion (DRG) stimulation placement for chronic lower extremity and back pain. Authors of the study noted the limited data examining the efficacy and safety of long-term use of DRG stimulation.

Sixty-seven subjects were studied post-implantation, enrolled in a permanent DRG stimulator implantation from June 2016 to January 2018 at the Rush University Medical Center in Wheaton, IL. Patients were evaluated for pain (numeric rating scale, 0 to 10), patient global impression of change (PGIC) and degree of disability (Owestry Disability Index) at 1, 3, 6, 12 and 18 months after permanent implantation. Data were compared between baseline and longest follow-up period and between groups of patients with follow-up of less than 6 months, 6 to 12 months, and greater than 12 months post-implantation. The median follow-up was 8 (3 to 12) months, with 26, 26, and 17 subjects in the less than 6 month, 6 to 12 month and greater than 12 month groups, respectively. Baseline NRS pain scores were 8 (6 to 9) and Owestry disability index 33% (28% to 37%).

At longest follow-up, median NRS pain scores fell to 5 (2 to 7), median Owestry disability index fell to 23% (15% to 30%), and median PGIC was 70% (40 to 85). Comparatively, there was no difference in change in NRS, Owestry disability index of PGIC from baseline among the less than 6 month, 6 to 12 month, and the greater than 12 month groups. Five patients (7.4%) required revision of leads placement, 2 (3%) had removal of leads following infection, and 1 patient had foot drop two months after implantation.

The study has shown that DRG stimulation was effective in reducing pain, increasing function and produced a clinically important improvement in PGIC; the sustained effect seen with long-term implantation with few complications was another important finding. “DRG is an ideal target for stimulation because it contains the cell bodies of primary sensory neurons and synapses with pathways to the spinothalamic tract,” the study authors concluded in their abstract. “Stimulation at the DRG allows greater specificity of dermatomal innervation of the painful body part, avoiding unnecessary stimulation of non-painful areas.”

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